| NPI | 1558715367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 320803) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 140607) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2021-06-22 |